title: Infected total hip arthroplasty treated by an irrigation-debridement/component retention protocol. A prospective study in a 12-case series with minimum 2 years' follow-up.
abstract: BACKGROUND
  Treatment of infection after total hip replacement (THR) is complex and costly. Debridement with component retention is an attractive solution. Success rates in the literature vary widely (18-90%) according to patient selection criteria. The present prospective study assessed the selection criteria used in our department.
  
  
  METHODS
  A prospective study included all patients (n=210) surgically managed for infection following THR between November 2002 and December 2008. Patients underwent debridement in case of acute infection: i.e., early postoperative infection within 1 month of THR, or secondary hematogenic infection with less than 2 weeks' evolution. Beyond this deadline or in case of implant loosening, implant replacement was performed. The debridement series thus comprised 12 patients (mean age, 69 ± 11.3 years; mean evolution from contamination was 4.8 ± 3.5 days). Bacteriologically adapted antibiotherapy was administered for 6 weeks intravenously followed by 6 weeks per os. Mean follow-up was 40 ± 23 months. No patient was lost to follow-up. The success criterion was apparent eradication of infection at a minimum 2 years, defined by absence of clinical, biological or radiological signs of infection and of death attributable to infection or treatment. Where infection was suspected, hip aspiration or peroperative sampling determined recurrence (identical bacterium) or reinfection (different bacterium).
  
  
  RESULTS
  There were nine cures (75%) and three failures. Mean Postel Merle d'Aubigné Score, at end of follow-up, was 17 ± 2. The three failures involved the same bacteria (two streptococci [one group B, one group G] and one Enterococcus faecalis) as implicated in the primary infection.
  
  
  CONCLUSIONS
  The present results are comparable to those in the literature but poorer than for implant exchange. The technique remains, however, an interesting alternative, allowing less complex surgery and lower cost.
  
  
  CONCLUSIONS
  Patient selection criteria need refining so as to increase success rates with this technique.
  
  
  METHODS
  Level IV; prospective non-randomized non-comparative study.
authors.affiliation: Department of orthopaedics and traumatology, Diaconesses-Croix Saint-Simon hospitals group, Croix-Saint-Simon, 125, rue d'Avron, 75960 Paris cedex 20, France. klouche shahnaz@yahoo.fr
authors.forename: S
authors.initials: S
authors.lastname: Klouche
authors.forename: L
authors.initials: L
authors.lastname: Lhotellier
authors.forename: P
authors.initials: P
authors.lastname: Mamoudy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D003646:Debridement; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000601:surgery*; D012086:Reoperation; D007507:Therapeutic Irrigation; D016896:Treatment Outcome